422 spa Abstracts

451 EPIDEMIC CONGENITAL SYPHILIS: RELATIONSHIP TO DRUG TREATMENT DURING PREGNANCY. BL McFarlin', SF Bottoms, BS Dock' and NB lsada. Dept. of OB/GYN, Wayne State Univ., Hutzel Hospital, Detroit, Ml.

OBJECTIVE: To detennine the efficacy of current treatment guidelines of syphilis in pregnancy in preventing congenital syphilis (CS).

STUDY DESIGN: We reviewed 197 cases of maternal syphilis identified prospectively over an 8 month period. Maternal syphilis was defined as women with +VDRL and +FTA, CS was defined as all stillbirths >20 wks born to women wit~ +VDRL and +FTA, and infants with +CSF VORL or WBC > 5/mm on a clear tap. Infants with presumptive or suspected CS.were excluded from analysis.

RESULTS:

Duration Dose N Congenital Syphilis Unaffected (n = 51) (n = 89)

< 1 year 1 dose 23 11.1% 88.9% Unknown 1 dose 9 69.6% 30.4% < 1 year 3 doses 20 28% 72% Unknown 3 doses 25 45% 55%

Duration of disease was the most significant risk factor for CS (p=0.002). There was a significant decrease in rates of CS with 1 injection when disease length was < 1 year duration (p<0.001). There was no difference in the rates of CS in women treated with 1 or 3 dose therapy if they had a rash or chancre during pregnancy.

CONCLUSION: Our data suggest single dose treatment is adequate for disease duration < 1 year, and implicate reinfection as the most likely explanation for treatment failure in this group. For duration > 1 year, the importance of receiving all 3 doses of trestment is paramount. The high rate of CS in the latter group indicates identification before or earlier in pregnancy will be necessary to prevent devastating consequences for the neonate.

452 CULTURE IS MORE EFFECTIVE TIIAN "SALINE WET PREP" IN DIAGNOSING TRICHOMONAS VAGINALIS IN A LARGELY ASYMYfOMATIC INNER-CITY PREGNANT POPULATION AT

,RISK FOR PRETERM BIRTH. P. Heine', E.· PattersOD, R. Parker, D. Draper, 1. French, W. Jones, 1. McGregor. Dcpt. Ob/Gyn, Univ. of Colo., Denver, CO. OBJECTIVE: 1. To determine the prevalence of trichomonas vaginal is (TV) infection in pregnant women on entry in~ prenatal care in an inner­city popUlation. 2. To compare conventional microscopic methods versus innovative culture techniques in diagnosing TV in both symptomatic and asymptomatic pregnant patients at risk for preterm birth. STUDY DESIGN: 1264 patients were tested at entry into prenatal care for TV by saline wet prcp and culture techniques (either InPouch TV or standard Diamond' s culture). Vaginal symptoms were ascertained through standardized questioning prior to examination. Wet preps were systematically examined by two highly experienced researchers and considered negative after 10 fields were viewed. Cultures were inspected from day 4 to day 7 or until positive results were obtained. Results were analyzed by the McNemar's Test for correlated proportions. RESULTS: TV infection was documented by one or both techniques in 110/1264 for a prevalence of 8.7%. Symptoms were present in only 20/110 patients (18.2%). Culture methods detected 105/110 (94.5%) of all patients while wet prep detected 801110 (73%) (p < .001). In symptomatic patients wet prep and culture were equally effective and diagnosed 85% and 95% of infections respectively (p = NS). Among asymptomatic patients culture detected 94.4% while wet prep detected 70% (p < .001). CONCLUSIONS: I. The prevalence of TV in this inner-city population was 8.7%; over 80% of patients being asymptomatic. 2. Culture techniques were superior to the conventional microscopic evaluation. 3. Accurate, cost-effective, "easy to use" TV culture (InPouch) techniques justify ongoing controlled trials of TV trestment during pregnancy as a means to decrease the prematurity rate.

January 1993 Am J Obstet Gynecol

453 GENITAL EXPRESSION AND PERINATAL TRANSMISSION OF HUMAN PAPILLOMAVIRUS. ~ LA Kou!sky,X KK Holmes,x D Goldman,x S-K Lee,X NB Kiviat, x J Kuypers, x DA Galloway.x Univ of W A, Seattle W A. OBJECTIVES: To assess changes in the incidence of dysplasia and genital human papilloma virus (HPV) DNA detection during and after pregnancy and to determine the rate of perinatal transmission of HPV. METHODS: An unselected cohort of pregnant women enrolled before 20 weeks gestation undergo interview, physical and colposcopic exam, blood draw, pap smear, and genital and oral sampling for HPV DNA by dot ftIter hybridization (DFH) and polymerase chain reaction (PCR) at <20 and 34 wks gestation, and at 6 and 52 wks postpartum(pp). At delivery, 6 wks, 6, 12, 24, and 36 months of age, infants undergo sampling from multiple sites for detection of HPV DNA by DFH and PCR and blood draw for HPV serology.

454

RFSUL TS: Tbru 8/20192, 128 women have enrolled and 70 have delivered. Results of maternal DFH and PCR tests, stratified by results of Pap smears arc as follows:

<20 wks 34 wks 6 wks pp Pap DFH+PCR+ DFH+PCR+ DFH+PCR+ NI or atyp. Bl89 4132 0/42 7/25 1/36 pending Dysplasia 6114 518 214 3/3 1/6 pending p-value· 0.003 0.008 0.006 0.04 0.27 (2 tail F exact) .p value comparing dysplasia to normal or atypical The rate of abnormal pap smear or colposcopy or of HPV DNA detection does not show a significant trend with advancing gestation or nonpregnant status. Thus far, none of the 40 infants tested have had evidence of HPV by DFH; PCR results are pending. CONCLUSIONS: The detection of HPV DNA was increased among women with dysplasia but did not vary consistently with pregnancy status. No evidence of vertical transmission of HPV has been detected, but PCR results must be completed and larger numbers studied.

FETAL EFFECTS OF E. COLI LIPOPOLYSACCHARIDE. E.R. Newton, N.T. Field, K. Kagan-Hallet,. W. Peairs.' Depts. of Ob/Gyn and Pathology, UTHSC, San Antonio, TX. OBJECTIVE: We sought to describe the fetal effects of an intrauterine injection of E. coli lipopolysaccharide (LPS). STUDY DESIGN: Under hysteroscopic visualization, we injected both uterine horns of 18 pregnant (70% gestation) rabbits with 0.2 cc solution containing 200 ~g or 300 ~g LPS. Control animals received 0.2 cc saline/horn (n=22). The animals were sacrificed at 96 hours, or when illness or preterm labor (PML) was noted. RESULTS: Animals had negative decidual cultures at sacrifice. Maternal fever was noted more often in the LPS­treated animals than in the saline-treated animals (50-63% vs 0%, p<O.01).

Treatment (n)

IUFO

BW(g ± SO)

SGA

200 IJg LPS (10) 300 IJg LPS (8) Saline (22)

21%* 26%* 6%

15.3 ± 2.6 16.8 ± 4.0 15.8 ± 2.0

B% U% D%

.p <0.01, LPS vs saline CONCLUSION: Intrauterine injection of several times the lethal IV dose of E. coli resulted in maternal fever and fetal death, but not reduced birthweights or SGA. Perhaps growth retardation has a mechanism different from that of endotoxin poisoning.